頭部外傷後にGuillain-Barré症候群を疑うpolyneuropathyを発症した1例

抄録

Guillain-Barré syndrome (GBS) is an autoimmunological demyelinating polyneuropathy that may occur after a traumatic event. We describe a case of suspected GBS following a traumatic brain injury. A 49-year-old man was transferred to our hospital after a motor cycle accident. On arrival, his consciousness level was GCS 14 and he had no motor weakness. Head CT revealed left acute subdural hematoma, cerebral contusion and traumatic subarachnoid hemorrhage. Conservative treatment was chosen, but right upper and lower limb weakness developed and his consciousness level worsened. Hematoma removal and craniotomy were performed 2 days after the trauma. The postoperative course was uneventful and the patient was extubated 3 days after the operation. However, respiratory failure, hypoxemia and circulatory disorder developed 3 days after the extubation, with accompanying loss of the deep tendon reflex and bilateral limb weakness. Neuromuscular disorder was suspected, and a spinal tap and motor conduction test revealed cyto-albuminological dissociation and axonal peripheral polyneuropathy. GBS was diagnosed and intravenous immunoglobulin was started 20 days after the trauma. The patient was weaned from the ventilator on the next day, and cerebrospinal fluid findings and clinical symptoms recovered gradually. He was discharged 6 months after the accident. The correct diagnosis of GBS in this case contributed to recovery of the patient.